To conceal or disclose a disabling condition? A dilemma of employment transition

Disclosure is recognised as an issue for people of working age with a mental illness. Disclosure may also be an issue for people of working age with physical disabilities and chronic illness who are endeavouring to obtain and retain employment within their diminished work capacity in the open labour market. This paper is based on qualitative research into the employment transition of 13 participants with a range of disabling conditions. The conditions included rheumatoid arthritis, osteoarthritis, cancer, depression, HIV/AIDS, fracture of the wrist, traumatic head injury, and intervertebral lumbar disc prolapse. Despite loss of work capacity resulting in loss of employment, the participants secured durable employment within their capacities after periods of time sometimes extending to many years. Participants were interviewed to gain insight into the disability-to-employment transition experience regardless of their diagnosis. Of the 11 psychosocial themes that emerged from the data, concealment was one that was frequently and spontaneously identified by participants. In this paper the theme of concealment in the disability-to-employment transition is explored in detail. Relevant implications are identified for vocational rehabilitation professionals.

Toward a great understanding of the willingness to request an accommodation: Can requesters' beliefs disable the Americans with Disabilities Act?

Although the Americans with Disabilities Act requires most employers to provide reasonable accommodation, there is reason to believe that people with disabilities are often unwilling to make such requests. The authors therefore focus on factors influencing the requester's likelihood of seeking an accommodation. By drawing upon the theories of planned behavior, help-seeking, and distributive justice, the authors propose a framework identifying several salient beliefs that may influence request likelihood and then explore the role of select situational characteristics in shaping these beliefs as a way to more fully understand the requester's assessment process.

The everyday ADA: The influence of requesters' assessments on decisions to ask for needed accommodation

Baldridge, D. C. (2002). "The everyday ADA: The influence of requesters' assessments on decisions to ask for needed accommodation." Dissertation Abstracts International Section A: Humanities and Social Sciences, 62(8-A): 2807.

The Americans with Disabilities Act grants the right to workplace accommodations. While accommodations are often essential to assure equal employment opportunities, there is evidence that people with disabilities often withhold requests for needed accommodations. This dissertation examines the information processing that precedes requesters' decisions to make, or withhold, requests. Specifically, I examine the influence of accommodation attributes and requesters' assessments of the personal consequences of asking for accommodation on requesters' decisions. First, in-depth interviews with a small group of people who are deaf and people who are hard-of-hearing were used to gain an understanding of the phenomena and combined with extant accommodation, help seeking and planned behavior theory to develop a model and hypotheses. Second, data from 238 surveys was analyzed using logistic regression analysis to test the hypotheses. Third, follow-up interviews were conducted to further illuminate findings. Accommodation attributes were hypothesized to both influence requesters' decisions directly and indirectly through their influence on requesters' assessments. Based on the initial interviews, and the help seeking and accommodation literatures, three specific assessments were hypothesized to be of particular importance: compliance, personal cost and normative appropriateness. As hypothesized, compliance-a requester's assessment regarding the likelihood of compliance with accommodation requests, and normative appropriateness-requester's assessment of what others think they should do-were both highly significant predictors. However, personal cost-concerns regarding inequity, indebtedness, loss of freedom/restrictions and damage to one's public image-was not significant. Based on the initial interviews, and the help seeking and accommodation literatures, three specific accommodation attributes were hypothesized to influence requesters' decisions: effectiveness, monetary cost and ease of use. As hypothesized, effectiveness was a strong predictor of decisions. In addition to directly influencing requesters' decisions, effectiveness also influenced requesters' compliance and normative appropriateness assessments. Contrary to expectations monetary cost and ease of use were not significant predictors of decisions. However, while these variables did not have a direct influence, both were significant predictors of requesters' assessments, and thus, had an important indirect influence. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Disclosure of a psychiatric disability in supported employment: An exploratory study

People with psychiatric disabilities entering the workplace and their supported employment providers frequently contemplate whether to disclose the supported employee’s disability and their support needs to employers and workplace personnel. This study examined the role of disclosing a psychiatric disability and the employment experiences of 162 people participating in ten supported employment programs in the United States. Results indicate that 82% of the supported employees had their disability disclosed in the workplace; however disclosure was typically made by the employment agency. The relation between who disclosed the disability, what was disclosed and the effect on employment outcomes (including typical employment experiences, job adjustment and workplace accommodations) are examined. Practical suggestions are identified for supporting individuals regarding disclosure.

Factors associated with disclosure of HIV/AIDS to employers among individuals who use job accommodations and those who do not

Conyers, L., & Boomer, K. B. (2005). "Factors associated with disclosure of HIV/AIDS to employers among individuals who use job accommodations and those who do not." Journal of Vocational Rehabilitation, 22(3): 189-198.

This article presents the findings from a research study investigating the patterns of job accommodation use and factors associated with disclosure of HIV/AIDS status to employers among a sample of 84 employed individuals with HIV/AIDS. Overall, more than half of the sample (52%, n = 43) used some form of job accommodation. Of these, 14% reported that they could not work without their accommodations and 34% indicated that they did not know if they could work without accommodation. Logistic regression analyses indicated that the factors associated with disclosure of HIV/AIDS status to employers are different among participants who used accommodations and those who did not. Implications for rehabilitation practice and research are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Stigma and disclosure: Implications for coming out of the closet

Background: There are costs and benefits for people with psychiatric disorders to decide to disclose publicly these disorders. Aims: The gay and lesbian community has struggled with the same tension and their discoveries about coming out may prove useful for the disclosure concerns of persons with mental illness. Methods: Lessons learned about coming out by the gay and lesbian community include a variety of models that map the stages for successfully coming out; e.g., identity confusion, comparison, identity acceptance, immersion, and identity synthesis. Navigating these stages requires consideration of the costs and benefits of disclosure; we review some of these including social avoidance and disapproval as key costs and improved psychological well-being and interpersonal relations as benefits. Conclusions: The paper ends with a review of levels of disclosure for people who opt to come out. Declaration of interest: This paper was made possible in part by MH62198-01 from the National Institute of Mental Health.

Perspectives of people with psychiatric disabilities on employment disclosure

The Americans with Disabilities Act (ADA) of 1990 protects people with disabilities from employment discrimination. Under the ADA, employers must accommodate the known disabilities of a qualified employee or applicant. For persons with psychiatric disabilities, which are often invisible, the individual is required to make a conscious decision regarding disclosing the disability to an employer. The decision to disclose is very complex because the person needs to consider the possibility of confronting stigma and negative stereotypes. A qualitative study including a focus group and individual interviews was conducted to gather data from 11 people (average age 45 years) with psychiatric disabilities/labels regarding employment disclosure. Major findings include the significant impact of disability identity (does the participant think they have a disability), and the importance of appropriate job matching as a disclosure strategy. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Accommodation and discrimination: Workplace experiences of individuals who are HIV+ and individuals with cancer

Maintaining one's role in the workplace despite significant health concerns can be important in meeting an individual's emotional and economic needs. This qualitative research study reviewed the workplace experiences of eighteen individuals who are HIV+ and fourteen people who have cancer. Questions addressed in the study included: what was the impact of their illness on their work life; whether they disclosed their health status and what was the reactions of co-workers and supervisors; what, if any, accommodations did they receive; what concerns did they have about their health and employment and who was supportive of them in dealing with employment issues. Significant findings included that there were many similarities in experiences between people who were HIV+ and those with cancer. Despite many common themes, there were some noticeable differences that included: (1) all of the people with cancer told people in their workplace of their health status as compared to a third of those who were HIV+; (2) an additional one-third of people who were HIV+ told selective co-workers or their supervisor and the final third told no one; (3) men who were HIV+ were more likely than women to have fully disclosed their status; (4) a greater percentage of people with cancer received accommodations and they typically received multiple accommodations; (5) both groups received a range of reactions from co-workers and supervisors, but the majority reported a positive response; (6) individuals who were HIV+ reported more negative reactions from co-workers or supervisors than those with cancer; (7) twice as many people who were HIV+ reported discriminatory experiences in the workplace; and (8) all of the people with cancer who felt they had been discriminated against had pursued legal avenues while none of the people who were HIV+ had explored their legal options. Recommendations for individuals with significant health concerns, employers and rehabilitation counselors are discussed. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Workplace experiences of individuals who are HIV+ and individuals with cancer

Maintaining one's role in the workplace despite significant health concerns can be important in meeting an individual's emotional and economic needs. This qualitative research study reviewed the workplace experiences of 18 individuals (aged 23-50 yrs) who are HIV+ and 14 people (aged 31-60 yrs) who have cancer. Questions addressed the following issues: the impact of illness on their work life; whether they disclosed their health status and, if so, the reactions of co-workers and supervisors; and what accommodations, if any, they received. Results indicate that although their health problems had a significant impact on their work life, they wanted to continue to work and enjoy the benefits that come from having a job. A majority of the Ss reported positive experiences. In most situations, others in the workplace were responsive, but it remains incumbent upon individuals to advocate for themselves in seeking to have needs met. Recommendations for individuals with significant health concerns, employers, and rehabilitation counselors are discussed. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Disclosure of HIV status in the workplace: Considerations and strategies

Reviews qualitatively the workplace experiences and disclosure decisions of 18 HIV-positive individuals (aged 23-50 yrs). The most frequently cited reasons for disclosing HIV status were to explain choices they were making as they interviewed for a job and concerns about their job performance and the need for accommodations. For individuals who disclosed their HIV status to selective members of the workplace or disclosed to no one, the primary reasons given were preference for privacy, nature of the work environment, and fear of possible consequences. In conclusion, the authors discuss the practice, policy, and research implications for social workers. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Workplace accommodation as a social process

Successful sustained employment for people with disabilities is a function of a complex array of factors. Key among these factors is appropriate accommodation at the workplace. Current approaches to accommodation, however, are often unsuccessful. Research suggests that this is due, in part, to the limited view of accommodation as technical changes to the job. An approach to accommodation that does not take into account the social context ignores the consequences of the process on work group morale and individual self-esteem and well-being. This has repercussions for individual job performance, job satisfaction and work retention, as well as overall work group productivity. An intervention was designed to take into account the social nature of the accommodation process and pilot tested with 12 workers who were out on a short term disability leave with a psychiatric diagnosis and their work groups. Based on a psychoeducational model, the intervention educates the work group about what it means to work with a disability, provides a safe environment where the worker with disability and coworkers can share concerns about the impact of accommodation on the group, informs about the accommodation process and specifies strategies to help the worker with disability best meet job requirements. Key intervention components include 1) the development of a disclosure plan since workplace intervention cannot occur without disclosure, 2) a systematic method for identifying the work group members, 3) a formal psychoeducation training that includes the supervisor, identified work group members, and the individual in the work organization who has the authority to approve accommodations, and 4) on-going follow up support to the supervisor and worker with disability. Although generalizability of the findings is limited because of the small sample size and its application only to those with mental health conditions, they support the importance of this approach to employment outcomes for people with disabilities. First, findings suggest that the rehabilitation process cannot stop at placement. Providers must be willing and able to enter the workplace with their clients. This requires providers to take on new roles such as educators, interpreters, negotiators and trainers. Disclosure must lose its status as a taboo topic. Providers and workers with disabilities must come to understand the risks and benefits of disclosure, and, when the decision is made to disclose, must have a formal, structured plan for carrying it out. Finally, workplace intervention must take into account the social context and provide the opportunity for communication and interaction in order to insure the success of the accommodations.

Use of the Americans with Disabilities Act by young adults with schizophrenia

Describes the impact of the Americans with Disabilities Act (ADA) on the work experience of young adults with schizophrenia. Responses of 20 Ss with recent-onset schizophrenia were assessed to key questions about the ADA and other work-related experiences to better understand the role of the ADA in their lives. Ss were categorized into 3 groups based on knowledge and use of the ADA. Group 1 (9 Ss) had no knowledge or use of the ADA, Group 2 (7 Ss) had knowledge of the ADA workplace accommodations but did no use them, and Group 3 (4 Ss) had knowledge of and used ADA accommodations. Four themes were identified from the experiences of people in Group 3 who were interviewed about their return to work. First, these 4 individuals recognized that their work history had value and allowed them to believe that competitive employment was possible for them. Each person realized that previous work experience could be used to identify a preference for future work. They understood that they may need to modify both their approach to job procurement and the amount had type of help obtained from mental health professionals. They found that disclosure to their employer could be beneficial, although they recognized that the decision to disclose their illness was a personal choice. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

The disclosure conundrum: How people with psychiatric disabilities navigate employment

The vocational rehabilitation and mental health literatures usually urge people with psychiatric disabilities to disclose their disability at work. Reasons for preferring disclosure include the opportunity to invoke rights conferred by the Americans with Disabilities Act of 1990, the risk of losing federal disability benefits when earning a higher income, and the belief--held by many professionals--that people with psychiatric disabilities will experience permanently debilitating symptoms. However, a newer model of recovery from psychiatric disability challenges these assumptions. A qualitative study of people with psychiatric disabilities explored these issues. The participants were current or former recipients of social security benefits provided to persons with significant disabilities. Participants described complex situations around employment and disclosure, which were more difficult to resolve than disclosure advocates have recognized. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

The role of psychiatric rehabilitation practitioners in assisting people in understanding how to best assert their ADA rights and arrange job accommodations

Granger, B. (2000). "The role of psychiatric rehabilitation practitioners in assisting people in understanding how to best assert their ADA rights and arrange job accommodations." Psychiatric Rehabilitation Journal, 23(3): 215-223.

Findings from focus groups indicate personal need for education and skills related to decisions about their ADA rights, job accommodations, disclosure and negotiation. Authentic empowerment emerges when practitioners replace their job and maintenance perspective with a teaching, skills development and peer support perspective to achieve independent career decision making over the long term.

Findings from a national survey of job coaches and job developers about job accommodations arranged between employers and people with psychiatric disabilities

Granger, B., Baron, R., & Robinson, S. (1997). "Findings from a national survey of job coaches and job developers about job accommodations arranged between employers and people with psychiatric disabilities." Journal of Vocational Rehabilitation, 9(3): 235-251.

Describes the method and results of a mailed survey completed by 194 job coaches and job developers who serve people with psychiatric disabilities. Job accommodations used most frequently include use of the job coach in facilitating communications, phone access to the job coach, use of positive feedback, option for part-time work and gradual task introduction. Costs for job accommodations for people with psychiatric disabilities are low. Disclosure takes place more often before the job offer where job coaches are involved. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

132 graduates with learning disabilities (LD) of a large, public, competitive postsecondary institution were surveyed to determine if they had self-disclosed their LD to their current employer and to provide the reasons for choosing to self-disclose or not to self-disclose. Based on a response rate of 67.4% (n=89), the results indicated that 86.5% of the respondents were employed full time. Although nearly 90% of the respondents stated that their LD affected their work in some way, only 30.3% self-disclosed to their employer. Of those who had not self-disclosed, the majority reported that there was no reason or need to self-disclose. However 46.1% reported not self-disclosing due to fear of a potentially negative impact in the workplace or due to a concern for job security. Specific rationales for disclosure and information related to the use of self-reported accommodations and strategies are presented. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

To tell or not to tell: Disability disclosure and job application outcomes

This article attempts to address partially the problem of ascertaining employers' decisions in the real world about hiring job applicants with a disability. Over a three month period, the research team responded to all (409) job advertisements for clerical positions that met certain parameters in the two major Hong Kong newspapers. Each advertisement received four application letters that were identical in every respect except one. One letter did not mention disability, one mentioned a hearing impairment, one mentioned walking with the assistance of crutches and one mentioned having recovered from a reactive depression. A positive outcome was judged to have occurred if the applicant was offered a job interview. A total of 1636 letters of application were sent and 331 positive responses were received. Multiple pairwise comparisons were made that demonstrated statistically significant differences between the non-disability group when compared with each of the disability groups. Comparisons of the disability groups with each other did not achieve levels of statistical significance. There was, however, a clear ranking of preference; people without a disability, followed by those with a hearing impairment, those using crutches to walk and finally, those who had had a depression.

The Americans with Disabilities Act and adults with learning disabilities as employees: The realities of the workplace

Price, L., Gerber, P. J., & Mulligan, R. (2003). "The Americans with Disabilities Act and adults with learning disabilities as employees: The realities of the workplace." Remedial and Special Education, 24(6): 350-358.

Adults with learning disabilities, ages 19 to 32, were queried to examine their employment experiences at job entry and in job advancement vis-a-vis the Americans with Disabilities Act (ADA). They were questioned regarding job acquisition; experiences on the job; job advancement; self-disclosure; and employer experiences, attitudes, and beliefs. The interviews indicate that provisions of Title I of the ADA currently are being underutilized by individuals with learning disabilities in the workplace. Self-disclosure about disability was rare, and, surprisingly, reasonable accommodations were used infrequently. These findings raise a number of important questions for consideration by the field of learning disabilities. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

The dynamics of disclosure: Its impact on recovery and rehabilitation

Disclosure of one's own experiences with psychiatric disability can be both exhilarating and depressing. This article shares experiences of the author and others in their disclosure, and provides some ideas about the risks and benefits of disclosure.

Effects of a social competence training program on accommodation request activity, situational self-efficacy, and Americans with Disabilities Act knowledge among employed people with visual impairments and blindness

Rumrill, P. D. (1999). "Effects of a social competence training program on accommodation request activity, situational self-efficacy, and Americans with Disabilities Act knowledge among employed people with visual impairments and blindness." Journal of Vocational Rehabilitation, 12(1): 25-32.

This article describes an experimental training program to increase knowledge, confidence, and participation in the Americans with Disabilities Act's Title I accommodation request process among employees who are blind or visually impaired (N=46). Participants in the experimental condition (n=23) completed a structured interview to identify their needs for reasonable accommodations, received detailed information about Title I provisions and about national accommodation resources, and completed an intensive social competence/self-advocacy program to develop skills in requesting on-the-job accommodations from their employers. Compared to a matched and randomly assigned control group (n=23), experimental participants were significantly more knowledgeable, confident, and active in the accommodation request process at a 16-week follow-up. Implications for Vocational Rehabilitation policy and practice are also discussed.